EMBARGOED NOT FOR RELEASE BEFORE 12:01 A.M. ET FRIDAY, NOVEMBER 20,... NEWS RELEASE

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NOT FOR RELEASE BEFORE 12:01 A.M. ET FRIDAY, NOVEMBER 20, 2015
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Mary Mahon: (212) 606-3853, [email protected]
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Twitter: @commonwealthfnd
NEWS RELEASE
Embargoed for release:
12:01 a.m. ET,
Friday, November 20, 2015
COMMONWEALTH FUND HEALTH CARE AFFORDABILITY INDEX
FINDS COSTS UNAFFORDABLE FOR A QUARTER OF WORKING-AGE
ADULTS WITH PRIVATE HEALTH INSURANCE
New Survey Finds Some Privately Insured Adults Are Skipping Needed Health
Care and Prescriptions
New York, NY, November 20, 2015—Health care costs are unaffordable for 25 percent of
privately insured working-age adults, according to the Commonwealth Fund Health Care
Affordability Index. The new index identifies 30 percent of people with moderate incomes and
53 percent with low incomes as having unaffordable
health care costs. People with exposure to high health
care costs relative to their incomes were the most likely to
skip needed health care and not fill prescriptions.
The new index was released today in the report, How
High Is America’s Health Care Cost Burden? Based on
an annual Commonwealth Fund survey of U.S. adults’
health costs, it measures premiums, deductibles, and outof-pocket spending as a share of income for a population
of insured people, made up primarily of people with
employer coverage (90%), but also including people in
marketplace plans (6%) and with individual coverage
(5%). A detailed description of the index and how it
defines affordability, can be found in the methods
description at the end of the press release. The
Commonwealth Fund will update the index regularly.
“Consumers feel the effect of health care costs every
time they pay their premiums or reach into their pockets
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at the doctor’s office,” said lead author Sara Collins, Vice President for Health Care Coverage
and Access at The Commonwealth Fund. “Our index looks at how working-age adults are
spending money on health care, using a fairly conservative measure of affordability to highlight
how many people have costs that likely make it difficult to afford other necessities like food and
housing.”
Can People Afford Their Premiums, Deductibles, and Copays?
According to the report, high deductibles are a major reason people struggle to afford health
care—43 percent of all of those surveyed and 51 percent of low- and moderate-income people
said their deductible is difficult or impossible to afford.
The report finds that some respondents’ perceive their cost burdens to be higher than what the
affordability index shows. According to the researchers, such perceptions are important because
they affect how people use their health plans to get care.
Most people find premiums and copayments or coinsurance somewhat easier to afford than
deductibles. Still, 34 percent of low-income adults (an individual making less than $23,340 a
year) reported difficulty affording their copayments and coinsurance.
Going Without Needed Health Care
The report finds that having high health care costs, particularly high deductibles, or a low income
often means going without care.
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
Forty percent of people with high deductibles relative to their incomes said they had not gone to
the doctor when they were sick, had not gotten a preventive care test, skipped a recommended
follow-up test, or had not gotten specialist care they needed because of their deductible.
Thirty-nine percent of low-income adults said that because of copayments or coinsurance, they
did not fill a prescription or go to the doctor when they were sick, skipped a medical test or
follow-up visit, or did not see a specialist when they or their doctor said they needed one.
“More Americans than ever have health insurance, but these findings show that too many people
with all types of coverage aren’t getting care because of high costs,” said Commonwealth Fund
president David Blumenthal, M.D. “As the Affordable Care Act moves into its next phase, when
it will focus on improving quality of care and keeping costs down, policies to mitigate cost
burdens for families may also be needed.”
Additional Survey Findings
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
Nearly two of five (37%) of adults said they were not aware or did not know whether their health
plan covered preventive services with no out-of-pocket costs, as required by the Affordable Care
Act. About half (49%) of low-income adults said they were not aware that preventive care was
fully covered.
A quarter (26%) of people who had been billed for services their insurer wouldn’t cover said it
was because the doctor was out-of-network.
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The full report will be available at: http://ww.commonwealthfund.org/publications/issuebriefs/2015/nov/how-high-health-care-burden when the embargo lifts.
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METHODS
The Commonwealth Fund Health Care Affordability Tracking Survey, July–August 2015, was
conducted by SSRS from July 15 to August 9, 2015 as a part of SSRS’s weekly nationally
representative omnibus survey. The survey consisted of a 15-minute telephone interviews in English or
Spanish and was conducted among a random nationally representative sample of 2,762 adults ages 19
to 64 living in the continental United States. Overall 1,060 interviews were conducted with
respondents on landline telephones and 1,702 interviews were conducted on cellular phones, including
1,116 with respondents who live in households with no landline telephone access. This is the second
wave of the Affordability Tracking Survey. The first wave was conducted in September 10–October 5,
2014. The analysis in this issue brief focuses on 1,687 adults who were insured continuously for the
prior 12 months with private coverage, either through an employer, the Affordable Care Act’s
marketplaces, or the individual market. The majority of the sample is comprised of people in
employer-based plans.
The data are weighted to adjust for the fact that not all survey respondents were selected with the same
probabilities, the overlapping landline and cellular phone samples, and disproportionate nonresponse
that might bias results. Data are weighted to the U.S. 19-to-64 adult population by age, race, gender,
region, marital status, education, and population density, based on the U.S. Census Bureau’s 2014
March Supplement to the Current Population Survey and household telephone use using the CDC’s
National Health Interview Survey. The resulting weighted sample is representative of the
approximately 190.7 million U.S. adults ages 19 to 64.
The survey has an overall margin of sampling error of +/– 2.1 percentage points at the 95 percent
confidence level. The landline portion of the survey achieved a 10 percent response rate and the
cellular phone sample achieved a 5.5 percent response rate. The overall response rate was 6.9 percent.
The Commonwealth Fund is a private foundation supporting independent research on health
policy reform and a high performance health system.
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